Due to this reputation of being a painful operation, advances in hemorrhoid surgery have focused on making it less painful. One such operation is stapled hemorrhoidectomy. Using a specially-designed, single-use stapler instrument (which was modified from the staplers used to reconnect intestines during major abdominal surgery), the hemorrhoids are excised and the anus repaired from the inside, something which is difficult to do with traditional surgery. The end result is that the surgical wound is inside, and no wound is visible outside the anus. Scientific studies have proven that this is less painful than traditional surgery, although with a small recurrence rate.

Another advanced surgical technique is Transanal Hemorrhoidal Dearterialization (THD). Using a doppler ultrasound, the blood vessel supplying the hemorrhoid is identified and ligated with stitches. Deprived of its blood supply, the hemorrhoid then shrinks and shrivels. Again there is no wound outside and is therefore almost painless. However, because it is a new technique, not very many studies evaluating its long-term effectiveness have come out.

All surgical procedures for hemorrhoids, whether traditional or innovative, may sometimes develop complications such as bleeding, infection and stricture. It is important therefore when seeking treatment, to see an expert in anal diseases.

The term hemorrhoids are associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed.

Many people have them without suffering from any symptoms, and therefore these may be safely left alone. Treatment is usually required for those whose hemorrhoidal symptoms such as excruciating throbbing pain affect quality of life and daily living. There are many traditional remedies and non-surgical treatments for hemorrhoids. However, if none of these work, surgical procedures may be required as a last resort.

How do hemorrhoids look and feel?

Hemorrhoidal cushions are skin, vascular and soft tissues that line the anal canal, playing a small role in defecation and continence. Everyone has them, although with our daily travails of straining and movement, they do change over time, becoming more lax or loose as we age.

Hemorrhoidal disease occurs when these changes result in bothersome symptoms such as bleeding, prolapsed, or pain. Almost everyone may develop symptoms at some point in their life, but these are not life-threatening, and may be safely observed. Treatment is usually required for those whose hemorrhoidal symptoms impact on quality of life and daily living.

What are the symptoms of hemorrhoids?

Bleeding from hemorrhoids is usually bright red, often dripping into the toilet bowl, or noticed when wiping. The stools themselves are normal looking, indicating that the bleeding is originating only from the anorectal area. Sludge of dark blood and stool mixed thoroughly together is usually from a source within the small and large intestines and not hemorrhoids. Hemorrhoidal bleeding is painless, and this differentiates it from anal fissures, which is also a very common anal condition that presents with similar bright red bleeding during defecation, but with anal pain.

Hemorrhoids only become painful when they thrombosed or incarcerated. Thrombosed hemorrhoids occur when blood clots within the hemorrhoids, causing very obvious swelling and pain. While surgery for this may be effective during the first 4 days of the attack, if left alone the swelling and pain gradually subside and disappear after 2 weeks. Usually this occurs just once or twice in a person’s lifetime, and it is uncommon to have repeated episodes of thrombosis.

Doctors often classify patients as to having either external or internal hemorrhoids. External hemorrhoids are located just outside the anus, and hence are always visible on routine inspection. Many people have them without suffering from any symptoms, and therefore these may be safely left alone. Sometimes external hemorrhoids may make cleaning difficult, allowing sweat and anal discharge to hide between folds, resulting in anal itching.

Internal hemorrhoids arise from inside the anus and are therefore only visible when, because of excessive laxity, they protrude outside. This condition is called prolapsed, and usually occurs during defecation. When internal hemorrhoids prolapsed they may either slip back inside on their own, or require manipulation by the person for it goes back in. When the prolapsed hemorrhoids cannot be returned, they become trapped outside, resulting in pain and swelling. This scenario is called incarcerated hemorrhoids.

What are the forms of treatment for hemorrhoids– surgical and non-surgical?

Hemorrhoids only require treatment when there are symptoms. And the type of treatment depends on the severity of symptoms. Mild symptoms may be managed just by eating a lot of fiber and taking in bulk laxatives such as psyllium to improve the consistency of stools and ease bowel movement. Some over-the-counter creams may provide symptomatic relief.

Non-surgical and almost painless treatments for hemorrhoids include injection sclerotherapy, infrared photocoagulation (often mislabeled as “laser treatment”), and rubber band ligation, any of which can be done safely in the clinic as an out-patient procedure. In scientific studies comparing these methods, rubber band ligation was found to be the most effective and cheap, which is why it is the most common non-surgical procedure for hemorrhoids in the world today.

Non-surgical treatment is often ineffective for large, incarcerated or thrombosed hemorrhoids. Surgery is usually recommended in these situations, and also when non-surgical treatment has failed to relieve symptoms. Traditional surgery requires cutting out the hemorrhoid using a variety of instruments such as scissors, knives, cautery, and ultrasonic dissectors. Unfortunately, any wound created in the outer skin of the anus results in often Sever post-operative pain, which is responsible for the reputation of hemorrhoid surgery being one of the most painful of operations.

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